Provider Demographics
NPI:1437740420
Name:AKITI, MIDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MIDA
Middle Name:
Last Name:AKITI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 S SORGHAM ST
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47334-9675
Mailing Address - Country:US
Mailing Address - Phone:217-504-1970
Mailing Address - Fax:
Practice Address - Street 1:417 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4019
Practice Address - Country:US
Practice Address - Phone:765-400-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28249875A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily